Mitral stenosis medical therapy: Difference between revisions

Jump to navigation Jump to search
VisualWikitext
(/* 2008 ACC/AHA Guidelines for the Management of Patients with Valvular Heart Disease - Medical Therapy for the Prevention of Systemic Embolization in Mitral Stenosis (DO NOT EDIT) {{cite journal| author=Bonow RO, Carabello BA, Chatterjee K, de Le...)
(/* 2008 ACC/AHA Guidelines for the Management of Patients with Valvular Heart Disease - Medical Therapy for the Prevention of Systemic Embolization in Mitral Stenosis (DO NOT EDIT) {{cite journal| author=Bonow RO, Carabello BA, Chatterjee K, de Le...)
Line 1: Line 1:
__NOTOC__
{{Mitral stenosis}}
{{CMG}}; '''Associate Editor-In-Chief:''' [[User:Mohammed Sbeih|Mohammed A. Sbeih, M.D.]][mailto:msbeih@wikidoc.org]; {{CZ}}
==Overview==
Patients with mitral stenosis who develop atrial fibrillation require anticoagulation and rate control.
==Asymptomatic Patients==
In asymptomatic patients, use endocarditis prophylaxis and chronic anticoagulation for intermittent or chronic atrial fibrillation, systemic embolism and marked LA enlargement (>55mm).
==Symptomatic Patients==
===Anticoagulation===
*[[Anticoagulant]] or [[antiplatelet]] medications (blood thinners) may be used to prevent clots from forming in patients with [[atrial fibrillation]]. The 2006 ACC/AHA guidelines on the management of valvular heart disease recommended long-term oral anticoagulation in patients with mitral stenosis who have a prior embolic event, left atrial thrombus, or atrial fibrillation <ref name="pmid18574274">{{cite journal| author=Salem DN, O'Gara PT, Madias C, Pauker SG, American College of Chest Physicians| title=Valvular and structural heart disease: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). | journal=Chest | year= 2008 | volume= 133 | issue= 6 Suppl | pages= 593S-629S | pmid=18574274 | doi=10.1378/chest.08-0724 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18574274  }} </ref><ref name="pmid18574273">{{cite journal| author=Singer DE, Albers GW, Dalen JE, Fang MC, Go AS, Halperin JL et al.| title=Antithrombotic therapy in atrial fibrillation: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). | journal=Chest | year= 2008 | volume= 133 | issue= 6 Suppl | pages= 546S-592S | pmid=18574273 | doi=10.1378/chest.08-0678 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18574273  }} </ref>.
===Digoxin===
*[[Digitalis]] may be used to strengthen the heartbeat and to slow the ventricular response in patients with atrial arrhythmias. Slowing the heart rate prolongs the diastolic filling time and allows better filling of the left ventricle.
===Diuretics===
*[[Diuretics]] may be used to remove excess fluid in the lungs in patients with pulmonary edema.
===Low Sodium Diet===
A low-sodium diet may be helpful.
===Activity Restriction===
Once a a patient develops symptoms, activity may be restricted.
==2008 ACC/AHA Guidelines for the Management of Patients with Valvular Heart Disease (DO NOT EDIT) <ref name="pmid18820172">{{cite journal |author=Bonow RO, Carabello BA, Chatterjee K, ''et al.'' |title=2008 Focused update incorporated into the ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease): endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons |journal=Circulation |volume=118 |issue=15 |pages=e523–661 |year=2008 |month=October |pmid=18820172 |doi=10.1161/CIRCULATIONAHA.108.190748 |url=}}</ref>==
==2008 ACC/AHA Guidelines for the Management of Patients with Valvular Heart Disease (DO NOT EDIT) <ref name="pmid18820172">{{cite journal |author=Bonow RO, Carabello BA, Chatterjee K, ''et al.'' |title=2008 Focused update incorporated into the ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease): endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons |journal=Circulation |volume=118 |issue=15 |pages=e523–661 |year=2008 |month=October |pmid=18820172 |doi=10.1161/CIRCULATIONAHA.108.190748 |url=}}</ref>==


Line 33: Line 7:
| colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
| colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
|-
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' [[Anticoagulation]] is indicated in patients with [[mitral stenosis]] and [[atrial fibrillation]] (paroxysmal, persistent, or permanent).''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])'' <nowiki>"</nowiki>
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' [[Anticoagulation]] is indicated in patients with [[mitral stenosis]] and [[atrial fibrillation]] (paroxysmal, persistent, or permanent). ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])'' <nowiki>"</nowiki>
|-
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''2.''' [[Anticoagulation]] is indicated in patients with [[mitral stenosis]] and a prior embolic event, even in [[sinus rhythm]].''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])'' <nowiki>"</nowiki>
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''2.''' [[Anticoagulation]] is indicated in patients with [[mitral stenosis]] and a prior embolic event, even in [[sinus rhythm]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])'' <nowiki>"</nowiki>
|-
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''3.''' [[Anticoagulation]] is indicated in patients with [[mitral stenosis]] with left atrial [[thrombus]].''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])'' <nowiki>"</nowiki>
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''3.''' [[Anticoagulation]] is indicated in patients with [[mitral stenosis]] with left atrial [[thrombus]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])'' <nowiki>"</nowiki>
|-
|-
|}
|}
Line 45: Line 19:
| colspan="1" style="text-align:center; background:LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]]
| colspan="1" style="text-align:center; background:LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]]
|-
|-
| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' [[Anticoagulation]] may be considered for asymptomatic patients with severe [[mitral stenosis]] and left atrial dimension greater than or equal to 55 mm by [[echocardiography]].*''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])'' <nowiki>"</nowiki>
| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' [[Anticoagulation]] may be considered for asymptomatic patients with severe [[mitral stenosis]] and left atrial dimension greater than or equal to 55 mm by [[echocardiography]].* ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])'' <nowiki>"</nowiki>
|-
|-
| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''2.''' [[Anticoagulation]] may be considered for patients with severe [[mitral stenosis]], an enlarged [[left atrium]], and spontaneous contrast on [[echocardiography]].''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''2.''' [[Anticoagulation]] may be considered for patients with severe [[mitral stenosis]], an enlarged [[left atrium]], and spontaneous contrast on [[echocardiography]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
|}
|}


{{cquote| <nowiki>*</nowiki> This recommendation is based on a grade C level of evidence given by the American College of Chest Physicians Fourth Consensus                              Conference on Antithrombotic Therapy. <ref name="pmid7555189">{{cite journal |author=Levine HJ, Pauker SG, Eckman MH |title=Antithrombotic therapy in valvular heart disease |journal=Chest |volume=108 |issue=4 Suppl |pages=360S–370S |year=1995 |month=October |pmid=7555189 |doi= |url=}}</ref> }}
{{cquote| <nowiki>*</nowiki> This recommendation is based on a grade C level of evidence given by the American College of Chest Physicians Fourth Consensus                              Conference on Antithrombotic Therapy. <ref name="pmid7555189">{{cite journal |author=Levine HJ, Pauker SG, Eckman MH |title=Antithrombotic therapy in valvular heart disease |journal=Chest |volume=108 |issue=4 Suppl |pages=360S–370S |year=1995 |month=October |pmid=7555189 |doi= |url=}}</ref> }}
==Sources==
*2008 Focused Update Incorporated Into the ACC/AHA 2006 Guidelines for the Management of Patients With Valvular Heart Disease <ref name="pmid18848134">{{cite journal| author=Bonow RO, Carabello BA, Chatterjee K, de Leon AC, Faxon DP, Freed MD et al.| title=2008 focused update incorporated into the ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to revise the 1998 guidelines for the management of patients with valvular heart disease). Endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. | journal=J Am Coll Cardiol | year= 2008 | volume= 52 | issue= 13 | pages= e1-142 | pmid=18848134 | doi=10.1016/j.jacc.2008.05.007 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18848134  }} </ref>.
==References==
{{Reflist|2}}
[[Category:Valvular heart disease]]
[[Category:Cardiology]]
[[Category:Cardiac surgery]]
[[Category:Surgery]]
[[Category:Overview complete]]
[[Category:For review]]
[[Category:Template complete]]
{{WikiDoc Help Menu}}
{{WikiDoc Sources}}

Revision as of 16:51, 7 November 2012

2008 ACC/AHA Guidelines for the Management of Patients with Valvular Heart Disease (DO NOT EDIT) [1]

Prevention of Systemic Embolization (DO NOT EDIT) [2]

Class I
"1. Anticoagulation is indicated in patients with mitral stenosis and atrial fibrillation (paroxysmal, persistent, or permanent). (Level of Evidence: B) "
"2. Anticoagulation is indicated in patients with mitral stenosis and a prior embolic event, even in sinus rhythm. (Level of Evidence: B) "
"3. Anticoagulation is indicated in patients with mitral stenosis with left atrial thrombus. (Level of Evidence: B) "
Class IIb
"1. Anticoagulation may be considered for asymptomatic patients with severe mitral stenosis and left atrial dimension greater than or equal to 55 mm by echocardiography.* (Level of Evidence: B) "
"2. Anticoagulation may be considered for patients with severe mitral stenosis, an enlarged left atrium, and spontaneous contrast on echocardiography. (Level of Evidence: C) "
“ * This recommendation is based on a grade C level of evidence given by the American College of Chest Physicians Fourth Consensus Conference on Antithrombotic Therapy. [3] ”
  1. ↑ Bonow RO, Carabello BA, Chatterjee K; et al. (2008). "2008 Focused update incorporated into the ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease): endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons". Circulation. 118 (15): e523–661. doi:10.1161/CIRCULATIONAHA.108.190748. PMID 18820172. Unknown parameter |month= ignored (help)
  2. ↑ Bonow RO, Carabello BA, Kanu C; et al. (2006). "ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (writing committee to revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease): developed in collaboration with the Society of Cardiovascular Anesthesiologists: endorsed by the Society for Cardiovascular Angiography and Interventions and the Society of Thoracic Surgeons". Circulation. 114 (5): e84–231. doi:10.1161/CIRCULATIONAHA.106.176857. PMID 16880336. Unknown parameter |month= ignored (help)
  3. ↑ Levine HJ, Pauker SG, Eckman MH (1995). "Antithrombotic therapy in valvular heart disease". Chest. 108 (4 Suppl): 360S–370S. PMID 7555189. Unknown parameter |month= ignored (help)
Retrieved from "https://www.wikidoc.org/index.php?title=Mitral_stenosis_medical_therapy&oldid=791643"